Innovative Surgery for Obstructive Sleep Apnea: Nerve Stimulator.
This article gives a comprehensive overview of current and upcoming hypoglossal nerve stimulation systems (Inspire, ImThera, and Nyxoah), the specific advantages of this approach, the selection criteria and screening process, relevant clinical data, and a description of the different implantation procedures. Upper airway stimulation and hypoglossal nerve stimulation appears to be a long-term, low-morbidity treatment for moderate-to-severe OSA patients suffering from CPAP incompliance. PMID: 28738358 [PubMed - in process]
Brooks DM, Brooks LJ. Reevaluating norms for childhood obstructive sleep apnea.J Clin Sleep Med. 2019;15(11):1557–1558.
Conclusions:The differential results of heritability and familial aggregation of OSA in normal weight and overweight subgroups substantiated the recommendation of separating childhood OSA into normal weight and overweight subtypes. In the overweight subgroup, there may be obesity-independent components involved in the genetic variance of OAHI, although a significant proportion of the genetic variance is shared with obesity.Citation:Au CT, Zhang J, Cheung JYF, Chan KCC, Wing YK, Li AM. Familial aggregation and heritability of obstructive sleep apnea using children probands.J Clin Sleep Med. 2019;15(11):1561–1570.
Conclusions:Our study suggests that patients with hypertension usingα1-adrenergic antagonists have a higher risk of sleep apnea. Routine sleep apnea screening would be beneficial for patients with hypertension who takeα1-adrenergic antagonists.Citation:Su P-L, Lin W-K, Lin C-Y, Lin S-H. Alpha-1 adrenergic-antagonist use increases the risk of sleep apnea: a nationwide population-based cohort study.J Clin Sleep Med. 2019;15(11):1571–1579.
Conclusions:OSA did not develop or worsen following primary palatoplasty. However, the oAHI increased by 5 or more events/h in approximately 20% of study participants. The presence of a syndrome was the only factor predictive of worsening OSA after palatoplasty. These findings suggest that palatoplasty does not worsen or cause OSA in most patients, and that nonsyndromic children are at low risk for the development or worsening of OSA.Citation:Bergeron M, Cohen AP, Maby A, Babiker HE, Pan BS, Ishman SL. The effect of cleft palate repair on polysomnography results.J Clin Sleep Med. 2019;15(11):1581–1586.
Study Objectives:Home sleep apnea testing (HSAT) is an efficient and cost-effective method of diagnosing obstructive sleep apnea (OSA). However, nondiagnostic HSAT necessitates additional tests that erode these benefits, delaying diagnoses and increasing costs. Our objective was to optimize this diagnostic pathway by using predictive modeling to identify patients who should be referred directly to polysomnography (PSG) due to their high probability of nondiagnostic HSAT.Methods:HSAT performed as the initial test for suspected OSA within the Veterans Administration Greater Los Angeles Healthcare System was analyzed retrospe...
Conclusions:This is the first study describing the characteristics of children and likely reasons for successful CPAP cessation. Children on CPAP should be regularly screened for ongoing CPAP need.Citation:King Z, Josee-Leclerc M, Wales P, Masters IB, Kapur N. Can CPAP therapy in pediatric OSA ever be stopped?J Clin Sleep Med. 2019;15(11):1609–1612.
Study Objectives:Drowsy driving related to obstructive sleep apnea (OSA) represents an important public health problem with limited data on the effect of positive airway pressure (PAP) therapy. We hypothesize that PAP therapy will reduce self-reported drowsy driving in a large clinic-based OSA cohort.Methods:Drowsy driving (self-reported near-accidents/accidents) incidents from baseline to after PAP therapy (stratified by adherence) were compared in a cohort of 2,059 patients with OSA who initiated PAP therapy from January 1, 2010 to December 31, 2014. Multivariable logistic regression models evaluated the dependence of ch...
Conclusions:Fitbit wearable devices showed an acceptable sensitivity but poor specificity. Consumer sleep trackers still have insufficient accuracy for clinical settings, especially in clinical populations. Solving technical issues and optimizing clinically-oriented features could make them apt for their use in clinical practice in a nondistant future.Citation:Moreno-Pino F, Porras-Segovia A, López-Esteban P, Artés A, Baca-García E. Validation of Fitbit Charge 2 and Fitbit Alta HR against polysomnography for assessing sleep in adults with obstructive sleep apnea.J Clin Sleep Med. 2019;15(11):1645–1653.
Conclusions:Objective adherence with MAD and CPAP is comparable and consistent over time. Self-reported adherence is higher with MAD than with CPAP giving rise to interesting discrepancy between objective and self-reported adherence with CPAP.Clinical Trial Registration:Registry:ClinicalTrials.gov; Identifier: NCT01588275Citation:de Vries GE, Hoekema A, Claessen JQPJ, Stellingsma C, Stegenga B, Kerstjens HAM, Wijkstra PJ. Long-term objective adherence to mandibular advancement device therapy versus continuous positive airway pressure in patients with moderate obstructive sleep apnea.J Clin Sleep Med. 2019;15(11):1655–1663.
There is a complex relationship among opioids, sleep and daytime function. Patients and medical providers should be aware that chronic opioid therapy can alter sleep architecture and sleep quality as well as contribute to daytime sleepiness. It is also important for medical providers to be cognizant of other adverse effects of chronic opioid use including the impact on respiratory function during sleep. Opioids are associated with several types of sleep-disordered breathing, including sleep-related hypoventilation, central sleep apnea (CSA), and obstructive sleep apnea (OSA). Appropriate screening, diagnostic testing, and ...